Drug Reference

Bone Cancer: Frequently Asked Questions

Here are some answers to frequently asked questions about primary bone cancer:

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What is primary bone cancer?

There are two categories of bone cancer—primary and secondary.

Primary bone cancer is a type of cancer that starts in the bones. The bones are the structures that support the body and protect the internal organs and tissues.

Secondary bone cancer starts elsewhere in the body and spreads to the bone. This section deals with primary bone cancer.

What are the risk factors for primary bone cancer?

There have not been any lifestyle risk factors, such as smoking, linked to primary bone cancer. These are some of the risk factors that have been linked to bone cancer:

Bone diseases. People with some bone diseases are at greater risk for getting primary bone cancer later in life. One of these is Paget disease. This condition makes the bones weaker than normal and, in rare cases, can lead to cancer. Another disease is hereditary multiple osteocartilaginous exostoses. This is an inherited condition that causes bumps to form on bones.

Radiation treatment. People who have had radiation treatments in the past for another type of tumor have an increased risk of developing primary bone cancer.

Inherited syndromes. Children with rare inherited syndromes including Rothmund-Thomson and Li-Fraumeni are at increased risk for developing bone cancer.

Hereditary retinoblastoma. Children with the hereditary form of retinoblastoma, which is a rare eye cancer, have been found to be at increased risk of developing bone cancer.

Age. Teenagers undergoing a growth spurt, and young adults in their early 20s, are at highest risk for the most common types of primary bone cancer. There may be a link between rapid normal bone growth and the formation of bone tumors, which is rapid, abnormal, uncontrolled bone growth.

Bone marrow transplant. A few people who have had a bone marrow transplant have later developed bone cancer.

What are the symptoms of primary bone cancer?

The symptoms of primary bone cancer depend on the person and on the size and location of the tumor. These are some of the most common symptoms of primary bone cancer:

Pain in the affected bone. The pain may come and go and usually seems worse at night. The pain will also usually increase with activity.

Swelling. There may also be swelling or a lump in the area of the tumor. This lump may not be noticeable at first.

Fractures. Bone cancer may weaken the bone in which it develops. Sometimes this can lead to a fracture.

Weight loss and fatigue. Sometimes bone cancer can cause a person to feel tired. Weight loss is another symptom.

These symptoms may be the result of primary bone cancer or of other, less serious causes. A person with any of these symptoms should see a healthcare provider right away.

What does primary bone cancer staging mean?

Once cancer is diagnosed with a biopsy (removal of a piece of tumor to be looked at under a microscope), it needs to be staged. Staging is the process of testing that's used to learn a cancer's grade and how widespread it is. Healthcare providers use X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and other tests to help determine the stage of primary bone cancer. It is important to know the stage so that the healthcare provider can determine your best treatment choices. The stage at diagnosis helps to determine prognosis (outlook) as well.

Bone cancers are also judged by how well-developed the cells are that make up the cancer. This is called the grade of the cancer. Grade 1 and 2 cancers are considered low-grade and tend to grow more slowly. Grade 3 and 4 cancers are high-grade and tend to grow and spread more quickly.

How is primary bone cancer treated?

A person with primary bone cancer may have one or more of these treatments:

Surgery. Surgery is typically the main treatment for bone cancer. The goal of surgery is to remove the tumor while saving limb function when preserving as much normal function and appearance as possible. If the tumor is on an arm or leg, the surgeon will try to save the limb, although in some cases amputation might be needed.

Chemotherapy. The goal of chemotherapy is to use medicines to shrink and destroy bone cancer cells. It can be used to shrink the tumor before surgery. It can also be given after surgery to try to lower the risk the cancer will come back, or it may be used to treat cancers that are more advanced. The medicine may be injected into the body through a vein. The medicine travels throughout the body killing cancer cells.

Radiation therapy. The goal of radiation is to kill cancer cells by using powerful X-ray energy. Healthcare providers also use radiation to ease the symptoms of bone cancer. External radiation uses a machine to direct radiation to the outside of the body. For internal radiation, a healthcare provider inserts radioactive substances inside the body.

Healthcare providers are always looking for new ways to treat bone cancer. They test new methods in clinical research trials. Before starting treatment, people should ask their healthcare provider if they should consider any clinical trials.

What are clinical trials?

Clinical trials are studies of new cancer treatments. Healthcare providers run clinical trials to learn how well new treatments work and what their side effects are. If a treatment looks promising, healthcare providers compare it to current treatments to see if it works better or has fewer side effects. People in these studies may get access to new treatments before FDA approves them for the public. These trials also help further the understanding of cancer and help people who may develop cancer in the future.

Should everyone get a second opinion for a diagnosis of primary bone cancer?

Many people with cancer get a second opinion from another healthcare provider. There are many reasons to get one. Here are some of those reasons:

Not feeling comfortable with the treatment recommendation

Being diagnosed with a rare type of cancer

Having several options for how to treat the cancer

Not being able to see a cancer expert

Many people have a hard time deciding which treatment to have. It may help to have a second healthcare provider review the diagnosis and treatment choices before starting treatment. It is important to remember that in most cases, a short delay in treatment will not lower the chance that it will work. Some health insurance companies even require that a person with cancer seek a second opinion. Many insurance companies will pay for a second opinion if asked.

How can someone get a second opinion?

There are many ways to get a second opinion. Here are some of them:

Ask a primary care healthcare provider. He or she may be able to suggest a specialist. This may be a surgeon who specializes in orthopedic oncology, a medical oncologist, or radiation oncologist. Sometimes these healthcare providers work together at cancer centers or hospitals. Never be afraid to ask for a second opinion.

Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). It has information about treatment facilities. These include cancer centers and other programs supported by the National Cancer Institute.

Seek other choices. Check with a local medical society, nearby hospital or medical school, or a support group to get names of healthcare providers who can give you a second opinion. Or ask other people who have had cancer for their recommendations.